MEDICARE: MR. JOSEPH BOUCHER OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5489	MA

General Provider Information

NPI Number	:	1578764668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH BOUCHER OTR

Provider Business Mailing Address
First Line	:	5 BIRCH DR
Second Line	:
City	:	SANDOWN
State	:	NH
Zip	:	03873-2515
Country	:	US
Telephone Number	:	603-887-1023
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 BIRCH DR
Second Line	:
City	:	SANDOWN
State	:	NH
Zip	:	03873-2515
Country	:	US
Telephone Number	:	603-887-1023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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